Suicide at Christmas

Abstract

A short cut review was carried out to establish whether the risk of suicide and parasuicide increases at Christmas. Fifteen
papers were found using the reported search, of which six presented the best evidence to answer the clinical question. The
author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses
of these best papers are tabulated. A clinical bottom line is stated.

Clinical scenario

You are planning for winter pressures in your emergency department. You wonder if you will need additional psychiatric support
over the Christmas period to cope with a perceived increase in the number of suicide attempts. When you bring this up at a
senior team meeting a colleague suggests that in fact the number of suicides decreases over the Christmas period. You wonder
if this is true.

Three part question

[In patients at risk of suicide/parasuicide] is [Christmas] a [high risk period]?

Search strategy

Medline(R) In-Process, Other Non-Indexed Citations, Medline 1966-07/2004 using the Ovid interface. [christmas.mp] AND [suicide.mp
OR exp suicide OR exp suicide, attempted OR parasuicide.mp].

Search outcome

Altogether 15 papers were found of which six were relevant to the clinical question. These papers are shown in table 6.

Comment(s)

Although the papers presented show a mix of suicide and parasuicide statistics it is apparent that there is a general trend
for such events to reduce in December and in particular around the days preceding Christmas day. As with all studies in this
area there may be difficulties in gauging the true incidence as a result of under reporting. This is unlikely to be significantly
different at Christmas so overall trends should be valid. The perception of many is that rates go up around Christmas. This
has resulted in a greater awareness and access to services at this time. It is an interesting question to ponder whether the
reductions seen here are attributable to an overall reduction in need, or the effectiveness of available help services.